Paediatrics

Around 1 in 10 cases of inflammatory bowel disease (IBD) will present before adulthood, with the median age at presentation being 11–12 years.1 IBD in children and young people is associated with more extensive disease, increased disease activity and a higher rate of complications compared with adult-onset IBD.2Worldwide, estimates of paediatric IBD prevalence rates are lacking, but data suggest its incidence is increasing.3

In our local population, faecal calprotectin varies with age. Children aged 1–3.9 years had higher concentrations of faecal calprotectin than adults, but there was no significant difference in faecal calprotectin between older children and adults.

There was a statistically significant correlation between fecal calprotectin and gastritis and severity of H. pylori infection. Fecal calprotectin level measurement can avoid unnecessary endoscopies and is also useful for evaluation of therapy response.

All three tests are very sensitive for detecting mucosal inflammation, but major differences exist between specificity and absolute values. It is highly advisable to use the test of the same manufacturer for follow-up and to monitor for disease activity.

Elevated levels of faecal calprotectin may indicate juvenile polyps in children. Examination with colonoscopy is still warranted in the pediatric population with elevated levels of faecal calprotectin.

No accumulation of calprotectin-rich leukocytes occurs in the healthy intestinal mucosa in the first months of life or later; therefore, the high calprotectin concentrations found, especially in some of the children in the youngest age groups, may reflect increased migration of neutrophil granulocytes into the gut lumen in early life.

The incorporation of noninvasive diagnostic tests into the initial diagnostic approach may avoid unnecessary invasive procedures and facilitate clinical decision-making when the diagnosis of IBD in children is initially uncertain.

Haemoglobin and platelet count provide a useful screening test combination for patients with suspected IBD. These tests are not completely reliable however. If clinical suspicion is high further investigations are required.

Based on high FCal, the majority of children had treatment escalation that resulted in clinical improvement. FCal measurements were useful and reliable in decision-making and clinical care of children with IBD.

Using a cutoff of 100 μg/g for normal values, the percentage agreement between the 2 tests was 87%. The optimal cutoff values to guide clinical decisions in the therapy of inflammatory bowel disease have yet to be determined.

These guidelines are intended to give practical (whenever possible evidence-based) answers to (pediatric) gastroenterologists who take care of children and adolescents with CD; they are not meant to be a rule or legal standard, since many different clinical scenario exist requiring treatment strategies not covered by or different from these guidelines.

FC is a valuable test for excluding IBD in patients who present with abdominal pain and diarrhoea. When the test is used in these ways patients avoid an invasive procedure and the hospital is saved the cost of the endoscopy.

FC levels may be a marker for early diagnosis and resolution of gastrointestinal illnesses in VLBW infants. Its utility for early diagnosis and assessment of resolution of NEC should be studied in a larger cohort of VLBW infants.

Compared with adults and children, healthy full-term and preterm neonates have high calprotectin levels. The measurement of calprotectin levels in faeces can be a promising noninvasive clinical screening test for intestinal distress in neonates.

The FC levels of children aged 1-18 months exhibit a downward trend with increasing age and are greater than the normal levels observed in healthy adults. In healthy children aged <6 months, FC levels are high. In children aged 6-18 months, FC concentrations are relatively low but are still higher than those of children aged >4 years.

A total of 126 infants born at a median gestational age of 33 weeks (range 25.7–35 weeks) were enrolled. Samples (n = 312) were collected weekly from the end of the first week of life until the end of the first month and if any gastrointestinal event occurred.

FC values found in this preliminary cohort of preterm neonates have been similar to those reported in the literature. The finding of a good correlation between the two techniques suggests the potential clinical usefulness of QuantumBlue at this age group (after validation).

ADA has been shown to be effective in children with moderate-to-severe CD. Treatment benefits should be weighed against side effects. Multicenter longitudinal studies with longer follow-up periods are required to determine the true efficacy and safety of long-term ADA treatment

While researchers grapple with the various avenues for prevention, early diagnosis and treatment of NEC, parallel efforts are required to improve practice based on current evidence and to precisely delineate the intermediate and long-term impact of NEC.

Among infants <33 weeks’ gestation, NEC appears to present at mean age of 7 days in more mature infants, whereas onset of NEC is delayed to 32 days of age in smaller, lower GA infants. Further studies are required to understand the etiology of this disease process.

The separation of NEC from SIP (Gordon’s classification) and the subsequent reduction of NEC into subgroups (NEC reductionism) together represent an improved operational framework for more accurately assessing NEC incidence and origin.

About Calprotectin

Faecal Calprotectin is a new biomarker which is helping to save money for the NHS by preventing unnecessary procedures on patients by screening out patients with IBS who do not require endoscopies.

The symptoms of functional disorders such as Irritable Bowel Syndrome (IBS) and organic inflammatory intestinal disease (IBD) can be very similar in presentation but are two very different medical conditions.